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증례 : 순환기 ; 좌회선지 원위부에서 우관상동맥이 기원하는 단일 관상동맥 기형 1예
박하욱 ( Ha Wook Park ),류시영 ( Si Young You ),윤재승 ( Jae Seung Yun ),이해미 ( Hae Mi Lee ),이수연 ( Soo Yeon Lee ),정욱성 ( Wook Sung Chung ),오용석 ( Yong Seog Oh ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S
선천성 심장이상을 동반하지 않은 단일 관상동맥 기형은 매우 드물고, 특히 우관상동맥이 좌회선지의 원위부에서 기시하는 경우는 현재까지 국내에서 1예, 전 세계적으로는 18예에서만 보고되었다. 단일 관상동맥 기형은 분류에 따라 급성 심장사를 일으킬 수 있는 경우가 있어 임상적으로 중요한 의의를 갖지만, 환자의 평가 및 치료에는 정확한 지침이 없는 실정이다. 저자들은 미세혈관 협심증으로 진단된 좌회선지 원위부에서 기원하는 우관상동맥을 보이는 단일 관상동맥 기형 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Single coronary artery (SCA) is a rare congenital anomaly and commonly associated with other congenital cardiac malformations. Some subgroups of SCA can lead to angina pectoris, acute myocardial infarction, or even sudden cardiac death in the absence of atherosclerosis. An anomalous origin of the right coronary artery, arising from the distal portion of the left circumflex artery, has previously been reported in a few cases. In this article, we report a case of a right coronary artery arising from the distal portion of the left circumflex artery with no other cardiac congenital anomaly. (Korean J Med 2011;80:S172-S177)
정규원(Kyu Won Chung),차상복(Sang Bok Cha),선희식(Hee Sik Sun),김부성(Boo Sung Kim),최규용(Kyu Yong Choi),이영석(Young Suk Lee),정욱성(Wook Sung Chung),홍영선(Young Sun Hong),박승만(Seung Man Park),이안희(Ahn Hee Lee),김진(Jin Kim) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.1
Rectal carcinoid tumor is relatively rare neoplasm orignated in Kulchitszky cell and clinicians have the difficulties in predicting their malignant potential and in proper treatrnent. The vast majority of rectal carcinoid tumors are benign and can be safely treated by local excision. Lesions larger than 2 cm and invading the muscular wall of the rectum should be considered rnalignant and treated by more radical surgery such as abdominoperineal resection. 3Ve had a case of 35-year-old male patient with a malignant rectal carcinoid tumor 2 cm in the length diagnosed by colonofiberscopy. So we present this case with a review of relevant literatures.
원인 불명의 실신 환자의 진단에 있어서 Head - up tilt Test 의 유용성과 혈관미주신경성 실신 환자의 임상적 특징
윤호중(Ho Joong Youn),정욱성(Wook Sung Chung),백상홍(Sang Hong Baek),김철민(Chul Min Kim),박인수(In Soo Park),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1994 대한내과학회지 Vol.47 No.2
Background: Syncope, defined as a transient loss of consciousness, is a frequently encountered symptom, but despite thorough clinical and invasive diagnostic investigation, the cause of syncope remains unexplained. In recent years, head-up tilt test has been of increasing interest as a diagnostic aids in patients with unexplained syncope. We studied to define the usefulness of various diagnostic test in the evaluation of patients with recurrent syncope, to assess the usefulness of head-up tilt test in the working of syncope of unknown origin and to evaluate the clinical characteristics of subgroups of patients with syncope induced by head-up tilt test. Methods: Between June, 1991 and November, 1992 at St. Mary`s hospital, 21 patients with history of syncope and 24 control subjects without history of syncope underwent 60° head-up tild test for 60 min. Results: 1) The definite cause for recurrent syncope were diagnosed in 10 of patients (47,6%) after clinical and invasive tests. 2) During head-up tilt test, vasovagal responses were provoked in 5 of 21 patients (23.8%) with recurrent syncope and 1 of 24 patients (4.2%) without syncope (p<0,05). 3) The head-up tilt test induced symptomatic bradycardia or hypotension in 3 of 10 patients (30%.) with negative electrophysiologic results. 4) During tilt induced vasovagal response, a) mean heart rate decreased to 42±24 beat/min from supine control of 70±12 beat/min (p<0. 05), b) mean systolic blood pressure decreased to 95±12 mmHg from supine control of 120±S mmHg (p<0,05), c) mean diastolic blood pressure decreased to 60±21mmHg from supine control of 72±13 mmHg (p<0.05), d) the time interval to onset of vasovagal response was 22±12 min. Conclusions: 1) In a large proportion of patients with recurrent syncope, the diagnosis remains unexplained despite a neurologic and cardiologic investigation including an electrophysiologic study. 2) Vasovagal responses are frequent cause in patients with recurrent unexplained syncope. 3) The head-up tilt test may be a simple, safe and highly yielding provocative test in the investigation of syncope of unknown origin.
Head - up Tilt Test 로 진단된 혈관 미주 신경성 실신 치험 1 예
윤호중(Ho Joong Youn),양종목(Jong Mog Yang),정욱성(Wook Sung Chung),노태호(Tae Ho No),채장성(Jang Seong Chae),김재형(Jae Hyung Kim),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1992 대한내과학회지 Vol.43 No.1
Vasovagal syncope is a common cause of unexplained syncopes. Rut even after clinical and invasive testing, a definite diagnosis is frequently not est8blished. We experienced a case of vasovagal syncope, diagnosed by head-up tilt test and treated by dual chamber pacemaker and beta blocker. The head-up tilt test may be a useful procedure in the investigation of vasovagal syncope, and bradyarrhythmia associated with vasavagal syncope may be suitable for treatment by permanent dual chamber pacemaker and β-blocker.
정상 및 본태성고혈압 환자에서 미세단백뇨 ( Microalbuminuria ) 에 대한 Enalapril 단독요법의 효과
김진일(Jin Il Kim),박인수(In Soo Park),안리숙(Lee Sook Ahn),박지원(Ji Won Park),윤호중(Ho Joong Youn),정욱성(Wook Sung Chung),김재형(Jae Hyung Kim),문언수(Un Soo Moon),최규보(Kyu Bo Choi),홍순조(Soon Jo Hong) 대한내과학회 1995 대한내과학회지 Vol.49 No.1
Objectives: Prognosis of essential hypertension has been proven to be majorly depend on the target organ damages(TODs). Renal target organ damage serves about 10% mortality in those essential hypertension. Thus prediction of renal TOD is very important in management of essential hypertension. Urinary microalbumin or microalbumin excretion rate (UAER) is thought to be useful early predictive for the renal TOD in diabetes and hypertension. Approximately 40 percent of essential hypertensive patients has been known to have increased UAER. And angiotensin-converting enzyme inhibitor (ACEi) has thought to be effective in decreasing microalbuminuria. This study was designed to evaluate effectiveness of ACEi(enalapril) on significant microalbuminuria in essential hypertension. Methods: 40 cases (M:F=13:27) were subjected in this study. After 4 weeks wash-out period, 24-hour ambulatory blood pressure monitoring (24-hr ABPM) and subsequent measurement of microalbuminuria in 24-hr urine were performed. After 12 weeks enalapril monotherapy, above examinations were repeated and the results were compared. Depend on initial results of 24-hr ABPM and UAER, the subjects were divided into 2 groups each; normotensive, hypertensive, UAER (above 20 ug/min) and non-UAER(less than 20 ug/min) group. Results. 1) After enalapril monotherapy for 12 weeks, whole-day average blood pressure was decreased significantly in whole subjects(n=40, from 145.68/ 94.92 to 123.55/ 81.50, p=0.0001) as well as in hypertensive group(n = 30, from 155.17/100.13 mm Hg to 126.30/83.70 mmHg, p=0.0001), UAER group(n=16, from 153.94/99.31 mmHg to 125.44/ 81.44 mmHg, p=0.0001) and non UAER group(n =24, from 140.17/92.00 mmHg to 122.29/ 81.54 mmHg, p=0.0006) except in normatensive group (n=10, from 117,20/79.30mmHg to 115.30/74.90 mmHg, p=NS). 2) UAER was significantly diminished in whole subjects( 28.14 30.54 vs 10.65 13.56 g/min, p= 0.0014), also in UAER group (from 54.91 33.36 g /min to 17.02 18.86 g/min, p=0.0004), in non UAEB group( from 10.29 4.95 to 6.40 5.70 g/ min,p = 0.015,n = 24), and in hypertensive group (from 32.09 33.25 g/min to 10.95 14.25 g/min, p = 0.0022), but not in normotensive group(from 16.31 16.46 g/min to 9.75 12.24 g/min, p=0.326). 3) Lipid profiles including total cholesterol, triglyceride and HDL-cholesterol were not changed in all groups. Conclusion; Microalbuminuria can be decreased by the administration of ACEi in essential hypertensives. And further study would be necessary to clarify those mechanisms.
박지원(Ji Won Park),이인석(In Seok Lee),이현승(Hyun Seung Lee),유기동(Ki Dong Yoo),전은정(Eun Jung Jun),박인수(In Soo Park),정욱성(Wook Sung Chung),노태호(Tae Ho Rho),이만영(Man Young Lee),채장성(Jang Seong Chae),김재형(Jae Hyung Kim 대한내과학회 1999 대한내과학회지 Vol.56 No.1
Swallowing syncope is a rare syndrome of a sudden and temporary loss of consciousness on swallowing. 66- year-old man was admitted due to dysphagia and syncope. He had no history of cardiac or gastrointestinal problem. In manometry, there was increased pressure of lower esophageal sphincter consistent to secondary achalasia and 24-hour Holter monitoring showed sinus arrest and atrioventricular block while swallowing. Head-up tilt test and provocation test with ballooning tube were shown mixed pattern of cardioinhibitory and vasodepressor response. Propranolol was given but not effective. Permanent pacemaker was implanted and there was no more syncopal episode. For evaluation of dysphagia symptom gastrofiberscopy was done and we found stomach carcinoma at the gastric cardia portion that infiltrated to the lower end of esophagus. Partial esophagogastrectomy with anastomosis was done and then the cardiac arrhythmias were disappeared. In the microscopic finding of gastroesophageal portion, it revealed tumor cells infiltrated to vagus nerve located in esophageal submucosa. We propose that swallowing syncope is induced mainly by esophageal abnormality with or without cardiac abnormality and stomach carcinoma metastasized to esophagus is an etiology of swallowing syncope. We report a case of swallowing syncope due to metastatic esophageal carcinoma involving vagal nerve.